Arterial spin labeling can distinguish between ischemic stroke and transient ischemic attack in intracranial stenosis more easily than high- resolution MRI

Abstract Purpose We aimed to investigate differential characteristics of plaque in the middle cerebral artery (MCA) and hemodynamics in patients with ischemic stroke and transient ischemic attack (TIA), and to compare the ability of high-resolution magnetic resonance imaging (HRMRI) and arterial spin labeling (ASL) to diagnose ischemic stroke. Methods In this retrospective analysis of patients with ischemic events who underwent HRMRI and ASL imaging between October 2020 and December 2023, clinical risk factors, vascular plaque characteristics, and the presence and characteristics of arterial transit artifacts (ATAs) at post-labeling delays (PLDs) of 1.5 s and 2.5 s were compared between stroke and TIA groups. Multivariate logistic regression analysis was used to evaluate the diagnostic performance of different prediction models combining clinical factors, differential plaque characteristics, and the presence of PLD ATAs. Results 147 patients (mean age, 57.12 ± 13.08 years; 102 men) were initially included in this study, included 79 and 68 patients from the ischemic stroke and TIA groups. There were significant differences in vascular positive remodeling, intraplaque hemorrhage, enhancement ratio and the presence of 1.5-s and 2.5-s ATAs (p Z = 0.742, p = 0.458). Conclusion ASL allows simpler imaging assessment than HRMRI to distinguish between TIA and stroke in patients with intracranial atherosclerotic stenosis. A model combining plaque characteristics and hemodynamic differences showed good performance. And ATAs assessments may become a more widely used imaging marker in clinical practice.